Research Commentary [7] June 2017

Jun 1, 2017

This is the third review in our series on Asian, migrant and refugee Child and Adolescent mental health.

Intergenerational conflict refers to the conflict between parents and children, between parents and grandparents and between grandchildren and grandparents (Potocky-Tripodi, 2002). The major source of intergenerational conflict in migrant families is differential acculturation rates between children and their parents/grandparents. In non-English speaking families new to New Zealand, children learn English before their parents and are often placed in the role of interpreter/translator for the family. Intergenerational role reversals may result in a loss of parental authority over children.

A major developmental task of adolescence is identity formation. CALD migrant and refugee background youth frequently experience substantial conflict regarding their ethnic identity. The task is compounded by the competing demands of two cultures. Whereas at school and with their peers, children are rewarded for westernising as quickly as possible, at home new habits and behaviours are discouraged.

Refugee and migrant children and young people and their families, confronted with cultural, linguistic, and socioeconomic barriers, are especially vulnerable to psychological problems. Among these problems are child and adolescent anxiety, depression, drug and alcohol abuse, sexual identity issues and in particular, in refugee populations post-traumatic stress disorder. Health practitioners working with refugees and migrant families in New Zealand require specialised knowledge of the CALD populations they serve and mainstream services and interventions need to be culturally adapted.

References:

Potocky-Tripodi, M. (2002). Best practices for social work with refugees and immigrants. New York: Columbia University Press. Link: https://cup.columbia.edu/book/best-practices-for-social-work-with-refugees-and-immigrants/9780231115834

Commentary provided by Dr Annette Mortensen, eCALD® Project Manager: Research & Development.

The following are articles reviewed:

Article 1: The importance of race and ethnicity: An exploration of New Zealand Pakeha, Maori, Samoan and Chinese adolescent identity.

This mixed-method study used a survey to examine the self-identifications, feelings of connectedness and diverse content of adolescents’ racial–ethnic identities (REI). The study surveyed the racial–ethnic self-identifications and content of 695 Year 9 students from five multi-ethnic urban high schools in Auckland. This age group (13-14 years old) was chosen because early adolescence is a critical time when adolescents must make sense of their place among the social groupings and racial–ethnic categories that exist in society and, more importantly for them, at school. The analysis in this study focuses on a comparison between four racial–ethnic groupings: New Zealand Pakeha, Maori, Samoan and Chinese.

Nearly half (48% N=68) of the Chinese adolescents in the study linked positive REI membership to Chinese culture, most notably the popularity of, and traditional activities associated with, Chinese food. Reference was also made to Chinese cultural expectations regarding academic success, that is, Chinese culture being “well focused on education” and “intellectual ability”. A number of respondents stated that they liked that “people think I am smart and good at Maths”, and “my parents encourage me to be successful”. Like all of the other cohorts in the study, Chinese respondents felt positively about their difference from others. However, over half of the Chinese respondents (54%) linked negative feelings about REI membership to experiences of discrimination, racism and stereotyping. Negative stereotypes have the power to seriously destabilise, Chinese adolescents’ feelings of security and belonging regarding their racial-ethnic and national identities.

Positive stereotypes, also known as model-minority stereotypes, were also noted as a negative aspect in that they were still viewed as an incorrect perception of all Chinese people. Although the content of the stereotype is positive, respondents perceived the intent as less positive, stating “I don’t like how people always stereotype Asians as smart” and “people assume we are good at maths and always think we are nerdy”. Chinese students are likely to experience anxiety when trying to uphold the expectations of these model minority stereotypes.

A fifth of the total responses (20%) also indicated that intra-group expectations concerning Chinese cultural and language maintenance, can be a negative aspect of Chinese group membership and leads to the adolescents feeling like they “can’t practise English” and are “not as free as others” because their “parents are more strict”. Students also referred to being pressured into “thinking too much about studies” and feeling frustrated with “what people expect of us”. In combination with the normative adolescent desire to establish a strong sense of individual identity and sense of belonging at school, factors like these could lead to a resistance towards positive Chinese REI development during adolescence.

Authors: Webber, M., McKinley, E. & Hattie, J.

Citation: Webber, M., McKinley, E. & Hattie, J. (2013). The importance of race and ethnicity: An exploration of New Zealand Pakeha, Maori, Samoan and Chinese adolescent identity. New Zealand Journal of Psychology, 42 (2), 17-28.

Publication

Article 2: Temporal association of stress sensitivity and symptoms in individuals at clinical high risk for psychosis.

The association between immigration and psychosis has been firmly established through more than twenty international studies and two meta-analyses, with an estimated relative risk of 2.1 to 2.7 for first generation immigrants relative to native-born populations (Cantor-Graae and Selten, 2005; Bourque et al., 2011). DeVylder et al. (2013) examined the association between acculturative stress and psychotic experiences in two first-generation immigrant groups Latino- and Asian-American in the United States (n = 2434). Acculturative stress was associated with visual and auditory hallucinations among Asians, but only with hearing voices among Latinos. Increased risk for psychotic-like experiences among Latinos was primarily associated with younger age of immigration. Acculturative stress appears to be a promising candidate mechanism explaining the relationship between immigration and psychosis, particularly among Asian Americans. Ethnic differences may reflect variability between groups that integrate more readily into the host culture and those that are subject to greater discrimination and environmental adversity.

References:

Bourque, F., van der Ven, E. & Malla, A.(2011). A meta-analysis of the risk for psychotic disorders among first- and second-generation immigrants. Psychol Med, 41,897-910. Link: https://www.ncbi.nlm.nih.gov/pubmed/20663257.

Cantor-Graae, E. & Selten, J-P. (2005). Schizophrenia and Migration: A Meta-Analysis and Review. Am J Psychiatry 162, 1. Link: http://mighealth.net/eu/images/5/53/Cant.pdf.

Authors: DeVylder, J.E., Ben-David, S., Schobel, S.A., Kimhy, D., Malaspina, D. & Corcoran, C.M

Citation: DeVylder, J.E., Ben-David, S., Schobel, S.A., Kimhy, D., Malaspina, D. & Corcoran, C.M. (2013). Temporal association of stress sensitivity and symptoms in individuals at clinical high risk for psychosis. Psychol. Med. 43 (2), 259–268.

Publication

Article 3: Supporting the mental health of young people from refugee backgrounds: A submission to the Victorian Government’s 10 year mental health plan.

The submission of the Centre for Multicultural Youth (CMY) in 2015 to the Victorian Government’s 10 year mental health plan, in support of improving the mental health of young people from refugee backgrounds, is informative for youth service provision in general in New Zealand and in particular for Child and Adolescent Mental Health Services (CAMHS).

The submission highlights the need to provide stronger generalist youth support that is culturally relevant for young people from refugee backgrounds. There needs to be stronger resourcing of culturally relevant youth support services, particularly in areas with high levels of settlement growth. Additionally, resources must be targeted towards building the capacity of mainstream services in these regions to meet the needs of these young people. This recommendation is of particular importance for the new areas of refugee resettlement being established in Dunedin and Invercargill; and additionally in the context of increasing the refugee quota to 1000 refugees per annum from 2018.

Of particular interest are approaches to improving mental health outcomes for young people from refugee backgrounds that work. These include a study by the University of Melbourne, Foundation House, CMY and the Royal Children’s Hospital which show the following facilitators to be effective (Colucci et al., 2015):

  • Practitioners understanding cultural definitions of mental health, illness and treatment
  • Culturally appropriate styles and approaches to working with refugee families
  • Service accessibility
  • Trust in the mental health practitioner and the service provider
  • Working with interpreters
  • Engaging family and community
  • Advocacy – holistically responding to self-identified needs of the young person; and
  • Continuity of care

Research has highlighted the importance of services demonstrating respect and understanding of a young person’s cultural background, including their cultural understandings of mental health. Culturally competent and sensitive mental health responses should take into account the young person’s gender, cultural and religious background, in terms of matching them with the most suitable mental health professional (Colucci et al., 2015).

References:

Colucci, E. Minas, H. Szwarc, J. Guerra, C. & Paxton, G. (2015). In or out? Barriers and facilitators to refugee-background young people accessing mental health services, Transcultural Psychiatry 52 (6), 766-790.

Authors: Centre for Multicultural Youth (CMY) (2015).

Citation: Centre for Multicultural Youth (CMY) (2015). Supporting the mental health of young people from refugee backgrounds: A submission to the Victorian Government’s 10 year mental health plan. Carlton, VIC: CMY.

Publication

Article 4: Challenges for Asian American LGBT Students.

Students who identify as gay and Asian American face marginalisation for both their cultural identity and sexual orientation, but also marginalisation of their sexual orientation because of their cultural identity and vice versa (Florido, 2014). Campus environments exert an important influence on college students experiences and outcomes (Museus, 2008) and support Asian students through providing culturally sensitive student counselling services.

Asian parents also tend to take longer to accept their son’s homosexuality. As Greene (1994) states: “the most salient feature of Asian-American families is the expectation of unquestioning obedience to one’s parents and their demand for conformity, consistent with the respect accorded elders and the sharp delineation of gender roles”. Along with this strict obedience, Asian-American males face a strong obligation to carry out one’s family name. Asian American men who identify as gay not only violates the cultural practice of one’s sex life as a private and individual topic, and prevents completion of familial obligations to promote the family name (Greene, 1994).

In Asian communities, sexuality is a private matter, one’s sexuality is not crucial to one’s identity. For many Asian cultures what Westerners would describe as homosexual activity does not necessarily translate to a homosexual identity (Mao et al., 2002). For example, being intimate with someone of the same gender does not necessarily mean that you are homosexual. As well, language poses a problem. Many gay Asian males find it very difficult to discuss their gay identity with parents who have a different vocabulary to talk about their son’ emerging homosexuality. Student health services in New Zealand need to be aware of the psychological and developmental stressors that are unique to gay Asian students to better provide them with counselling services.

References:

Greene, B. (1994). Ethnic-minority lesbians and gay men: Mental health and treatment issues. Journal of Consulting and Clinical Psychology, 62 (2), 243-251.

Mao, L. M. (2002). Ethnic and gay identification: Gay Asian men dealing with the divide. Culture, Health & Sexuality, 4(4), 419-430.

Museus, S. (2008). The role of ethnic student organizations in fostering African American and Asian American students' cultural adjustment and membership at predominantly white institutions. Journal of College Student Development, 49 (6), 568-586.

Authors: Florido, M.A.

Citation: Florido, M.A. (2014). Challenges for Asian American LGBT Students. New York: New York University.

Publication